An unprecedented health care crisis is unfolding in area hospitals as diminishing numbers of nurses are caring for seemingly endless waves of critically ill COVID-19 patients, a panel of nurses and nursing executives warned Tuesday.
The current surge of COVID-19 patients — nearly all of them unvaccinated — are flooding emergency rooms and intensive care units in this region and across the nation. Simultaneously, nurses continue to leave the profession due to the stresses, with some even taking their own lives, according to participants in a Zoom call with the news media hosted by the Virginia Nurses Association.
A trio of nurses from Johnston Memorial Hospital in Abingdon described how the growing shortage of nurses is impacting patient care, wait times and ramping up the pressure on everyone. Other participants were from Arlington, Charlottesville and Richmond.
“Nurses feel disrespected by communities who initially hailed them as heroes but now refuse to follow the simple steps that would ease their burdens like wearing masks and getting vaccinated,” Linda Shepherd, chief nursing officer at Johnston Memorial Hospital and president of the VNA, said. “Our nurses are mentally depleted, exhausted and traumatized experiencing pandemic-related PTSD with little or no time to seek mental health services. Suicide among nurses and other members of the medical community is also on the rise.
“The international nursing shortage that existed pre-pandemic has now been exacerbated, resulting in acute care bed closures due to a lack of nurses to provide patient care. The fallout from this shortage is bleak as it continues to grow and attack health care and health care services,” Shepherd said.
While no statistics were available, Shepherd said there have been incidents of health care providers taking their own lives.
“Within our own system we have had suicides of nurses and other health care professionals and we have had nurses over the past six months they have lost tremendous amounts of weight being unable to focus or get themselves in a place where they’re emotionally settled, so they just stop eating. All of these things are impacting all of our nurses here in Virginia as well as across the nation,” Shepherd said.
Health care providers have repeatedly “pleaded” with the public to wear masks and get vaccinated but those pleas seemingly fall on deaf ears.
As of Tuesday only 41% of residents of Northeast Tennessee and Southwest Virginia were fully vaccinated against the coronavirus — a rate substantially lower than state and U.S. averages.
“I don’t know what it’s going to take,” Shepherd said. “Sometimes I see within my own facility, until someone has a personal experience with someone passing with COVID, sometimes this just does not hit home. … It is not a reality to a lot of these people, and I don’t know how we get that message across more succinctly. I’m not really sure.”
Aliese Harrison, a 23-year nursing veteran who works in the Johnston Memorial ICU cried as she related the story of a patient she began taking care of this week.
“Monday, I had a 40-something-year-old, big man grip my hand and squeeze it so hard that it hurt and tell me how afraid he was,” Harrison said. “We were about to intubate him, and we tried to explain everything. He wanted to know how long he would be down, and the doctor said at least a week, probably two maybe three. What a scary thing to hear. This person has children and a wife. All I can do is tell him I’ll do the best I can do for him.
“We got him stable, and I had to call his wife, because she can’t be there, and explain to her and she’s crying the whole time. This is going on and on and on and it is taxing and we are exhausted, but we are going to keep on doing it,” Harrison said.
Harrison said she and her family continue taking precautions not to contract the virus, wearing masks when going out, using hand sanitizer regularly and getting vaccinated. Harrison said every patient she has taken care of during this current surge is unvaccinated, and it is frustrating to see people outside the hospital act as if nothing is happening.
“It’s been a year and half since this began and we have all these resources available to protect people and prevent them from getting COVID-19 but it’s not happening. We [region] are at 41% vaccination rate right now. I thought we would be in a different place at this point, so I’m a little angry and frustrated because the people we’re getting now are way more sick and they are younger. … I’m taking care of 40- and 50-year-olds that are dying,” she said.
Harrison regularly sees otherwise healthy people whose only health issues might be hypertension or being overweight being placed on ventilators and often not surviving.
“We need our communities to help us out. We love caring for people. We want to get people better, but we can’t always. We are losing more people than saving when they come to my critical care unit,” Harrison said.
On Tuesday Ballad Health reported it was treating 387 COVID inpatients across its system with 110 in intensive care units with a system record 90 on ventilators. For the past two months, well over 90% of all its patients hospitalized with COVID-19 were unvaccinated.
Through the first three weeks of September, the region’s hospital system has treated an average of 384 inpatients daily — which ranks well above the January surge that peaked at 361 inpatients. Additionally, 72 area residents have died from the coronavirus over the past seven days.
Across Virginia, COVID patients occupy 57% of all ICU beds in the state while 43% of ICU beds remain available, according to the Virginia Hospital and Healthcare Association.
Rates are much higher in Tennessee, where only 6% — 120 of over 2,000 ICU beds — were available, according to the Tennessee Department of Health.
Raymond Luchini, a nurse working in the COVID unit at Johnston Memorial, said the differences between last year and the present surge are startling.
“Now we’re overwhelmed. All the floors are full, ER is taking mainly COVID exposure patients,” he said. “In med-surg we work closely with ER, ICU, progressive care; we’ve got patients everywhere.”
Luchini said both the volume of patients and their acuity are taking a toll on health care workers.
“When patients get in the hospital their main worry is when are they going to see their family again,” he said. “It’s hard to explain you’re on oxygen you cannot go home with and you’re stuck here with us until we get you better — hopefully. But knowing in the back of our head they usually get worse before they get better.
“We take that home to our families; you can’t just leave it at work. It’s getting harder and harder to go home and have a sense of peace that you did all you could do,” Luchini said. “We keep praying and hoping the numbers die down; that people take care of themselves.”
Ashley Fogleman, an ER nurse at Johnston Memorial Hospital, graduated from nursing school last May so taking care of COVID patients is all she’s known.
“We have less staff, the patients I’ve seen in the ER are much sicker — I don’t know if they’re waiting longer to come in — and the strain is so much stronger. What we’re experiencing in the ED [emergency department] is the ratios are so much higher, our patients are much more critical. Last week I had three ICU patients, a PCU patient plus three or four ED patients all at once.”
She said the Abingdon facility is currently “overloaded.”
“The ratios are being increased every time I go to work just because we don’t have the staff to take care of the patient load and we can’t turn patients away. We’re not able to provide the individualized care we strive to as nurses. … I feel like it’s just passing medications, making sure these patients aren’t dying and then going on to the next one,” Fogleman said.
That is resulting in extensive waiting times and causing other problems.
“We’re seeing long, long wait times, a lot of aggravated patients, aggravated family members and friends. We’ve got so many ambulances coming in we don’t have room for them,” Fogleman said. “There is a misconception — if I come in by ambulance I expect to get a bed so we’re experiencing a lot of impatience from family members and patients. We’ve got rooms, but we’re holding patients for days — 40 to 50 hours if not more.”
That is because there aren’t enough nurses to adequately staff those rooms.
Fogleman said sometimes entering the waiting room means facing an “angry mob” but she understands their frustrations.
“If you’re in the waiting room, chances are you’re stable. We just want you to be patient with us,” she said. “I want people to realize we’re still working hard and we’re trying to save other lives in the back. Just because you can’t see us doesn’t mean we’re not working; that our coworkers aren’t working.
“Just be patient with us,” Fogleman said. “We go home after each shift stressed and tired but we still manage to come back the next day or the next shift and do it all over again.”
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